As children learn to walk, there are multiple possible deviations in their walking pattern that you may notice. Two of the more common gait deviations that we see as physical therapists are out toeing and in-toeing, also known as duck footed and pigeon toed, respectively.
If a child has an out toeing gait pattern, their feet will turn outwards while they walk. Out-toeing is sometimes referred to as “duck footed”. Out toeing or “duck footed” is the opposite of pigeon toe, which we explain below. There are multiple causes for out-toeing and most often are due to skeletal abnormalities, muscle imbalances, or is neurological in nature. Skeletal abnormalities may be outward rotation of the thigh bone in the hip joint (femoral retroversion) or outward rotation of the lower leg bone (external tibial torsion.)
If a child has a neurological diagnosis or high/low muscle tone, this may lead to a flat foot position. Often, children with flat feet may also walk with an out toeing gait pattern. If there is an imbalance in muscle strength and length of the hip muscles, the tighter outer hip muscles may pull on the hip and rotate the hips outwards, especially if the muscles on the inside of the hips are weaker.
Comparatively, if a child has an in-toeing gait pattern, their feet will turn inwards while they walk. In-toeing is sometimes referred to as “pigeon toed”, which is the opposite of duck toed. This gait pattern may also be caused by skeletal abnormalities, muscle imbalances, or is neurological in nature. If a child is in toeing, they may have inward rotation of the thigh bone in the hip joint (femoral anteversion) or inward rotation of the lower leg bone (internal tibial torsion.)
Typically, higher muscle tone of the inner thigh muscles associated with neurological diagnoses causes an in-toeing pattern. The structure of your child’s foot may impact their gait, specifically if the inner portion of their foot appears to be concave and the outside of their foot appears convex (metatarsus adductus.)
If there is an imbalance in muscle strength and length in the hip muscles, the tighter inner hip and thigh muscles may pull on the hip and rotate the hips inwards, especially if the muscles on the outside of the hips are weaker. Physical therapy can help to address these gait deviations.
Below is a list of exercises you can practice at home with your child to work on building their strength and flexibility.
Below are a few suggestions for pigeon toe exercises to try with your child.
We hope you found this pigeon-toed vs. duck-footed overview helpful. If your child is walking with either of these gait deviations, especially if it is impacting his or her balance, safety, or ability to keep up with his or her peers, it may be necessary to schedule a pediatric physical therapy evaluation so a PT can customize a home exercise program specifically for your child. An individualized home exercise program will help you understand how to correct pigeon toe (in-toeing) or duck footed (out-toeing) gait patterns.
Micayla Pedrick is a pediatric physical therapist at NAPA Center Boston. Micayla’s favorite springtime activity is growing fresh vegetables and herbs in her garden to cook with in new recipes. Her 3-year-old Husky, Theo, loves to keep her company while frolicking through the yard and gobbling up delicious zucchini, cucumbers, and tomatoes!